I'm quite upset as I write this. I will keep this post short since it's so late and I just feel like crying. I am on 20 of Oxy LA twice a day and 5 of Percocet for BT paintwice a day-which I use all of everyday. This is not reducing my pain enough so I can @ least get out of the house. I was on the therapeutic level of Neurontin, which didn't help my painful toes. I asked my PM nurse (Nurse Practitioner) why my toes hurt this much for, and she said to go see my Neurologist, which I did. Neuro said the toe pain is related to the scar tissue in my back. Finally an answer! So, he decreased my Neurontin to 900 and added 60 of Cymbalta. Six weeks later, and my toes felt much better!! When I returned for my monthly visit to NP, I told her what happened and she said "great". She can also see on the computer what my Neuro did since they are in the same hospital system. I have asked her twice if I can be increased to three 5mg Perc's instead of two, or slightly increase the Oxy. That's when she pulls out the strong ammo. and asks, "have you ever seen our video on Spinal Cord Stim?" or have you ever thought about it? When I tell her my Neuro doesn't think SCS is such a good idea, then everything gets dropped, including my pain relief!! I have ALWAYS been "the good patient" . Afraid of asking for what I want and doing everything they tell me to do,like;Pool Therapy, TENS etc. At my June visit she said do you want to have an increase now, or wait and see what you feel like after your injection. I said let's wait. So, I had the injection and it worked for a measely eight days. I went back to see her last week and when I brought up increasing my pain meds, she said," well the first step before increasing your pain meds, is to increase your Neurontin". We just went to the HIGHEST END of Neurontin a few months ago-(I told her) Also, how can she keep increasing my Neuro(again) when my Neurologist had just adjusted it-and my toes are better?? So, I guess my biggest question is this- Has anyone ever heard of increasing your meds for your Neuro symptoms first, before increasing your Pain Meds???? I have other complaints as well but I see it's well past midnight. I will bring them up another time. Sorry for being so long-winded. I hope EVERYONE has a pain-free weekend--janiee08.

I think that I would be inclined to say that your neurologist chose the dosage of neurontin and Cymbalta carefully to control your toe pain and that you don't want to change anything as it would make sense that your neurologist wouldn't like you changing the doses that he prescribed. Neurologist beats NP every time. I don't think he'd be happy at all. You could even get his office to fax a copy of the dosage of neurontin and Cymbalta that he would like you to stick to - why change something that's working?

I think that NPs do this because they can do it without consulting the dr - in other words, it's easier. I'd ring your neuro and explain your fears - that you might lose the toe pain relief that you've finally found because she's changing your meds. Once the neuro has made it clear that your neurontin dose should remain stable, you can bring up better pain relief through increasing your pain meds - I'd probably actually say 'I think that I need that increase in pain meds that you suggested for after I had my injection' and put it back on her.

If you don't want to go to your neuro, I think that the NP would take you seriously if you just told her that your neuro wouldn't like you changing around your neurontin doses now that you've finally found the right dose to work well - without increased side effects. If you've found the dose that works, why raise it? I feel your pain. My old gp (years ago) was terrified of pain meds and used to throw masses (like 400mgs +++) of tramadol and 3600mg neurontin at me each time she saw me. It was insane because I couldn't tolerate tramadol which I'd told her time and again, it wasn't until I had to go to hospital for massive pain (and seretonin syndrome from the tramadol!) that the hospital changed me to Oxycontin and she was finally comfortable to keep writing it (because the hospital had made the first move). i also had major thoracic surgery too.

i hope it all works out, I'll be thinking of you, so please let me know what you decide to do. I'd be inclined to ring your NP today or Monday and say that you 'remember' that your neuro put you on those doses specifically and as they worked, wanted you to stick with them. Just see what she does. Good luck!

Jema, thanks so much for replying, and for thinking of me. At my last appt. with her that I wrote about, she said that if you want an increase in pain meds, then you'll have to see the doctor the next time and ask him. I won't see him for two months! Now, I may see him this Thursday when I get my injection, unless a resident does it-not sure. If it's not the PM doc that does my injection, then I'll call the office and make an earlier appt. In the past, she(the NP) has said things like; I was just looking for a quick fix when I had my surgery, everytime you come here, you have a different problem. When I asked for an increase this time or trying another med. she said, "when does it end"? I should have said,"when 50% of my pain is gone". She also said, "well you can't be completely pain freeeeee". I certainly could tell the doc, but I have done this(reporting bad nurses to other docs,twice) and all they do is stick up with the nurse!! I have never abused my meds, gotten early refills, ended up in ER for more meds or anything like that. I've been with this practice for almost a year, and I don't even have a contract or have ever been asked to do a drug test. So, it seems the PM doc trusts me, I just don't know what's up with the NP Well thanks for letting me vent. This PM stuff makes me crazy It's not bad enough that we have to suffer from pain 24/7. It's also not like any of us asked for this pain! They just don't get it--janiee08.

janiee:
I would definitely stick to what your neurologist has done for the nerve pain. If anything should be changed, then increasing the Cymbalta would seem to be in order. It could possibly help your pain even better without having to increase any of the narcotic pain medications. But if they NP had suggested raising the dose of your narcotic meds then I would remind her about what she had suggested and go ahead and do it. But do ask about going up a little on the Cymbalta. The effective dose is usually between 90mg - 120mg. However, if you do do increase it and you expereince side effects that are intolerable or severe then you would know to go back down to what you were taking at least. Good luck and keep us posted.